Emotional back pain: the cause for our country's biggest problem?

The No. 1 cause of disability within Australia is back pain, according to a new paper published in The Lancet.

In fact, the Global Burden of Disease Study found that it remains the leading cause of breakdown worldwide.

Protecting the pain: It can be counter-intuitive.

Renowned physiotherapist and best-selling author Sarah Key believes how we feel is at least partly to blame for the epidemic.

Key, who has been practising for nearly 40 years, says that as a young practitioner she had dismissed the link between emotions and back pain.

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Sore spine? Relax.

Thousands of patients later and Key is convinced of the link.

"The older I've got, I've realised how huge it is," says the 65-year-old, who has been made a Member of the Victorian Order by the Queen.

What shifted her perspective?

"I think there were two dual processes going on in my mind – one was how outcomes had very little to do with the pathology shown on the scan and a lot to do with the patient's psyche – to do with stuff like being a catastrophiser."

To be clear, Key says there has to be susceptibility in the first place.

"Now emotional problems, I don't think cause a back problem out of thin air, I really don't," Key explains, "but I think they magnify it and I think that if you are a catastrophiser ... [it makes it] very hard to get better."

Indeed. New research has found that anxiety can intensify pain and also strengthen pain pathways in the brain leading to chronic discomfort.

"When people learn skills to decrease the physiological markers of anxiety or stress, they are simultaneously treating pain," said Stanford's Dr Beth Darnall, of the study.

Certainly, most of us can appreciate how tension and stress manifests itself into gnarly knots in our necks and shoulders.

Prolonged stress and emotional tension result in muscles that are chronically clenched and don't know how to switch on and off properly.

This can make us more brittle, Key explains.

Interestingly, and worryingly, given about 80 per cent of Australians experience back pain and a similar percentage are sedentary, sustained pressure – from sitting a lot, for instance – causes back problems. But, Key says, a greater force of sustained pressure is tension.

Add the two together and, as Key says, "you're setting the stage to jink a link".

But, it's more than that.

Fear that our spine – our pillar of support both physically and metaphorically – is fragile or flawed can create the very things we are afraid of as we tense around it and stop moving in healthy ways.

"If people think there's something inherently wrong about their back ... it is so easy to start protecting yourself, start not doing stuff, start feeling like you must curtail your activity," Key says.

Being too precious about our spines is often the exact opposite of what we should be doing, Key says.

"Fear-avoidance behaviour has been shown to be part of the disabling pathway in chronic low back pain," says Dr Aage Indahl, who specialises in stress, health and rehabilitation.

"Cognitive interventions, designed to remove fear and uncertainty, and to give the patient the confidence that the back is robust even if it hurts, seem promising."

Adds Key: "There are a couple of old wives' tales about backs that need to be expunged from the lexicon of bad backs and that is that you shouldn't lift, that you shouldn't bend, that you should roll over like a log to get out of bed, you should sit bolt upright and ... that's all to do with protecting your back and ... there's this sort of nexus between this emotional 'I've got to look after myself here' and ... we self-restrict.

"Don't suddenly do it all, but physiological loading [lifting and carrying and bending and doing stuff within activities of daily living] are really the best thing the body can do – at least from a skeletal point of view because it keeps cartilage pumping, it keeps bones strong and plastic – i.e. not brittle, it keeps tendons all of the right length and it keeps the muscles strong."

Sarah Key's 8 tips for a healthy spine

– Stretch over strength. "Strength you need to have ... but it is lack of stretch that cobbles you over and it is lack of stretch that tethers you into the repetitive stooped postures of function," says Key, who is a strong advocate of yoga.

– Decompression. Lie with a back block or yoga brick between the shoulder blades to reverse the extended hunching in front of a computer that we do.

– Don't rely on the gym to get you through. Jarring, repetitive movements offer "diminishing returns", Key says, and constant contracting of muscles can even exacerbate a problem.

– FInd a good, firm bed. "We used to sleep on skins on the floor."

– Keep calm. A worldwide study of centenarians found a common character trait was calmness. Key says we shouldn't underestimate its importance to our health.

– Find a good physio or masseuse with good hands. Find the point of pain and prise it free. "When they find the pain it is no longer hiding in your spine and holding you to ransom."

– Breathe properly — through the nose. "Good breathing is another casualty of a stressful life," Key says, explaining poor breathing uses the accessory muscles in the neck and can result in pain.